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Drug Interactions between Tanzeum and Tequin Teqpaq

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

gatifloxacin albiglutide

Applies to: Tequin Teqpaq (gatifloxacin) and Tanzeum (albiglutide)

CONTRAINDICATED: Gatifloxacin may interfere with the therapeutic effects of insulin and other antidiabetic agents. The use of various quinolones has been associated with disturbances in blood glucose homeostasis possibly stemming from effects on pancreatic beta cell ATP-sensitive potassium channels that regulate insulin secretion. However, hypoglycemia and hyperglycemia have been reported more frequently with gatifloxacin than with other quinolones. Gatifloxacin-induced hypoglycemic episodes have generally occurred within the first 3 days of therapy and sometimes even after the first dose, while hyperglycemia usually occurred 4 to 10 days after initiation of therapy. Death has been reported in severe cases. Coadministration of gatifloxacin with sulfonylureas (most often glyburide) and/or other oral hypoglycemic agents has resulted in severe, refractory hypoglycemia and hypoglycemic coma. Elderly patients and patients with reduced renal function are particularly susceptible.

MANAGEMENT: The use of gatifloxacin is contraindicated in patients with diabetes mellitus. Other quinolones may be safer alternatives in such patients, although all quinolones should be used with caution. Blood glucose should be closely monitored whenever quinolones are prescribed to patients receiving insulin or other antidiabetic agents, especially if they are elderly or have renal impairment. Patients should learn to recognize the symptoms of hypoglycemia such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia. If hypo- or hyperglycemia occur during quinolone therapy, patients should initiate appropriate remedial therapy immediately, discontinue the antibiotic, and contact their physician.

References

  1. (2001) "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb
  2. Gajjar DA, LaCreta FP, Kollia GD, et al. (2000) "Effect of multiple-dose gatifloxacin or ciprofloxacin on glucose homeostasis and insulin production in patients with noninsulin-dependent diabetes mellitus maintained with diet and exercise." Pharmacotherapy, 20 (6 Pt 2), s76-86
  3. Roberge RJ, Kaplan R, Frank R, Fore C (2000) "Glyburide-ciprofloxacin interaction with resistant hypoglycemia." Ann Emerg Med, 36, p. 160-3
  4. Rubinstein E (2001) "History of quinolones and their side effects." Chemotherapy, 47 Suppl 3, p. 3-8
  5. Menzies DJ, Dorsainvil PA, Cunha BA, Johnson DH (2002) "Severe and persistent hypoglycemia due to gatifloxacin interaction with oral hypoglycemic agents." Am J Med, 113, p. 232-4
  6. Baker SE, Hangii MC (2002) "Possible gatifloxacin-induced hypoglycemia." Ann Pharmacother, 36, p. 1722-6
  7. (2003) "Hypoglycemia and hyperglycemia with fluoroquinolones." Med Lett Drugs Ther, 45, p. 64
  8. Donaldson AR, Vandiver JR, Finch CK (2004) "Possible gatifloxacin-induced hyperglycemia." Ann Pharmacother, 38, p. 602-5
  9. LeBlanc M, Belanger C, Cossette P (2004) "Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy." Pharmacotherapy, 24, p. 926-31
  10. Biggs WS (2004) "Hypoglycemia and hyperglycemia associated with gatifloxacin use in elderly patients." J Am Board Fam Pract, 16, p. 455-7
  11. Gavin JR 3rd, Kubin R, Choudhri S, et al. (2004) "Moxifloxacin and glucose homeostasis: a pooled-analysis of the evidence from clinical and postmarketing studies." Drug Saf, 27, p. 671-86
  12. Saraya A, Yokokura M, Gonoi T, Seino S (2004) "Effects of fluoroquinolones on insulin secretion and beta-cell ATP-sensitive K(+) channels." Eur J Pharmacol, 497, p. 111-7
  13. Lin G, Hays DP, Spillane L (2004) "Refractory hypoglycemia from ciprofloxacin and glyburide interaction." J Toxicol Clin Toxicol, 42, p. 295-7
  14. Khovidhunkit W, Sunthornyothin S (2004) "Hypoglycemia, hyperglycemia, and gatifloxacin." Ann Intern Med, 141, p. 969
  15. Happe MR, Mulhall BP, Maydonovitch CL, Holtzmuller KC (2004) "Gatifloxacin-induced hyperglycemia." Ann Intern Med, 141, p. 968-9
  16. Greenberg AL, Decerbo M, Fan J (2005) "Gatifloxacin therapy associated with hypoglycemia." Clin Infect Dis, 40, p. 1210-1
  17. Blommel AL, Lutes RA (2005) "Severe hyperglycemia during renally adjusted gatifloxacin therapy." Ann Pharmacother, 39, p. 1349-52
  18. Brogan SE, Cahalan MK (2005) "Gatifloxacin as a possible cause of serious postoperative hypoglycemia." Anesth Analg, 101, p. 635-6
  19. Graumlich JF, Habis S, Avelino RR, et al. (2005) "Hypoglycemia in inpatients after gatifloxacin or levofloxacin therapy: nested case-control study." Pharmacotherapy, 25, p. 1296-302
  20. Frothingham R (2005) "Glucose homeostasis abnormalities associated with use of gatifloxacin." Clin Infect Dis, 41, p. 1269-76
  21. Bhasin R, Arce FC, Pasmantier R (2005) "Hypoglycemia associated with the use of gatifloxacin." Am J Med Sci, 330, p. 250-3
  22. McMorran M, Morrison H, Letourneau G (2006) Gatifloxacin (Tequin): hypoglycemia and hyperglycemia. http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/carn-bcei_v13n3_e.html#1
  23. Park-Wyllie LY, Juurlink DN, Kopp A, et al. (2006) "Outpatient gatifloxacin therapy and dysglycemia in older adults." N Engl J Med, 354, p. 1352-61
  24. Zvonar R (2006) "Gatifloxacin-induced dysglycemia." Am J Health Syst Pharm, 63, p. 2087-2092
  25. Zhanel GG, Fontaine S, Adam H, et al. (2006) "A Review of New Fluoroquinolones : Focus on their Use in Respiratory Tract Infections." Treat Respir Med, 5, p. 437-465
  26. Yip C, Lee AJ (2006) "Gatifloxacin-induced hyperglycemia: a case report and summary of the current literature." Clin Ther, 28, p. 1857-66
  27. Tomita T, Onishi M, Sato E, Kimura Y, Kihira K (2007) "Gatifloxacin induces augmented insulin release and intracellular insulin." Biol Pharm Bull, 30, p. 644-7
View all 27 references

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Drug and food interactions

Moderate

albiglutide food

Applies to: Tanzeum (albiglutide)

MONITOR: Glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists can delay gastric emptying, which may impact the absorption of concomitantly administered oral medications. Mild to moderate decreases in plasma concentrations of coadministered drugs have been demonstrated in pharmacokinetic studies for some GLP-1 receptor agonists (e.g., exenatide, lixisenatide), but not others. According to the prescribing information, liraglutide did not affect the absorption of several orally administered drugs to any clinically significant extent, including acetaminophen, atorvastatin, digoxin, griseofulvin, lisinopril, and an oral contraceptive containing ethinyl estradiol-levonorgestrel. Likewise, no clinically relevant effect on absorption was observed for concomitantly administered oral drugs studied with albiglutide (digoxin, ethinyl estradiol-norethindrone, simvastatin, warfarin), dulaglutide (acetaminophen, atorvastatin, digoxin, ethinyl estradiol-norelgestromin, lisinopril, metformin, metoprolol, sitagliptin, warfarin), or semaglutide (atorvastatin, digoxin, ethinyl estradiol-levonorgestrel, metformin, warfarin). The impact of dual GLP-1 and GIP receptor agonist tirzepatide on gastric emptying was reported to be dose- and time-dependent, with the greatest effect observed after a single 5 mg dose but diminished after subsequent doses. When acetaminophen was administered following a single 5 mg dose of tirzepatide, acetaminophen peak plasma concentration (Cmax) was decreased by 50% and its median time to peak plasma concentration (Tmax) delayed by 1 hour. However, no significant impact on acetaminophen Cmax and Tmax was observed after 4 consecutive weekly doses of tirzepatide (5 mg/5 mg/8 mg/10 mg), and the overall exposure (AUC) of acetaminophen was unaffected. Tirzepatide at lower doses of 0.5 mg and 1.5 mg also had minimal effects on acetaminophen exposure.

MANAGEMENT: Although no specific dosage adjustment of concomitant medications is generally recommended based on available data, potential clinical impact on some oral medications cannot be ruled out, particularly those with a narrow therapeutic index or low bioavailability, those that depend on threshold concentrations for efficacy (e.g., antibiotics), and those that require rapid gastrointestinal absorption (e.g., hypnotics, analgesics). Pharmacologic response to concomitantly administered oral medications should be monitored more closely following initiation, dose adjustment, or discontinuation of a GLP-1 receptor agonist or a dual GLP-1 and GIP receptor agonist.

References

  1. (2005) "Product Information. Byetta (exenatide)." Amylin Pharmaceuticals Inc
  2. (2010) "Product Information. Victoza (liraglutide)." Novo Nordisk Pharmaceuticals Inc
  3. (2014) "Product Information. Tanzeum (albiglutide)." GlaxoSmithKline
  4. (2014) "Product Information. Trulicity (dulaglutide)." Eli Lilly and Company
  5. (2016) "Product Information. Adlyxin (lixisenatide)." sanofi-aventis
  6. (2022) "Product Information. Ozempic (1 mg dose) (semaglutide)." Novo Nordisk Pharmaceuticals Inc
  7. (2023) "Product Information. Mounjaro (tirzepatide)." Eli Lilly and Company Ltd
  8. (2023) "Product Information. Mounjaro (tirzepatide)." Lilly, Eli and Company
  9. Eli Lilly Canada Inc. (2023) Product monograph including patient medication information MOUNJARO tirzepatide injection. https://pdf.hres.ca/dpd_pm/00068421.PDF
View all 9 references

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Minor

gatifloxacin food

Applies to: Tequin Teqpaq (gatifloxacin)

Concurrent ingestion of calcium-fortified foods (i.e., cereal, orange juice) may alter the bioavailability of gatifloxacin. The mechanism is chelation of calcium and the quinolone, resulting in decreased bioavailability. In the case of orange juice, inhibition of intestinal transport mechanisms (P-glycoprotein or organic anion-transporting polypeptides) by flavones may also be involved. Data have been conflicting: One study has reported no effect with milk coadministration. Another study reported a modest decrease in gatifloxacin bioavailability (13.5% decrease in Cmax,12% decrease in AUC, 15% increase in total clearance) when taken with 12 ounces of calcium-fortified orange juice instead of water, which could be clinically significant if the infecting organisms have borderline susceptibilities. The manufacturer states that gatifloxacin may be taken without regard to food, milk, or calcium. Clinicians should be aware of the possibility of an interaction if subtherapeutic effects are observed.

References

  1. (2001) "Product Information. Tequin (gatifloxacin)." Bristol-Myers Squibb
  2. Wallace AW, Victory JM, Amsden GW (2003) "Lack of bioequivalence of gatifloxacin when coadministered with calcium-fortified orange juice in healthy volunteers." J Clin Pharmacol, 43, p. 92-6

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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